1. Medicaid and Non Title IV-E Making Medicaid Happen: Providing Title XIX to Non Title IV-E Populations Sharon McCartney, JD AAICAMA, APHSA

2. 2 © 2007 by The Interstate Compact on Adoption and Medical Assistance State-Funded Adoption Assistance States have the option of extending Medicaid to children receiving state funded adoption assistance without regard to the income of their adoptive parents. Federal law: Section 1902(a)(10)(ii) of the Social Security Act

3. 3 © 2007 by The Interstate Compact on Adoption and Medical Assistance The COBRA Option Medicaid eligibility for state-funded adoption assistance eligible children can be through the COBRA option. 49 states and the District of Columbia have elected the COBRA option

4. 4 © 2007 by The Interstate Compact on Adoption and Medical Assistance What is the COBRA option? States are not required to provide Medicaid to their state-funded adoption assistance eligible children. States have the option to provide Medicaid to their state-funded adoption assistance eligible children. This option is the COBRA option.

5. 5 © 2007 by The Interstate Compact on Adoption and Medical Assistance COBRA Eligibility Criteria The COBRA option has three criteria: 1. An existing, legally executed adoption assistance agreement between the State and an adoptive parent or parents; 2. A pre-existing need for special medical rehabilitative care that the state finds would have precluded adoption absent medical assistance; and

6. 6 © 2007 by The Interstate Compact on Adoption and Medical Assistance COBRA Eligibility Criteria 3. Before or at the time the adoption assistance agreement was executed, (a) (at the state’s option) the child would have been eligible for medical assistance given his/her own income and resources (i.e. Title IV-E criteria used to determine payment for children in foster care rather than standards and methodologies of the state’s AFDC program under Part A of Title IV) or (b) the child was receiving or was eligible to receive Medicaid as either mandatory or optional categorically needy.

7. 7 © 2007 by The Interstate Compact on Adoption and Medical Assistance COBRA Reciprocity States are not required to provide Medicaid to children who live in their state who are receiving state-funded adoption assistance from another state. They can choose to do this- this is called reciprocity. Once a state has chosen reciprocity, it can provide Medicaid services to children who: live in their state, receive state-funded aa from a different state, and meet COBRA eligibility criteria.

8. 8 © 2007 by The Interstate Compact on Adoption and Medical Assistance Extending Reciprocity Not all states extend reciprocity in the same way. The two most common examples of how states extend reciprocity include offering reciprocity to children from: All states or ICAMA member states only

9. 9 © 2007 by The Interstate Compact on Adoption and Medical Assistance Reciprocity and Interstate Cases When a child receiving state-funded AA is placed for adoption across state lines or permanently moves, you must know: If the new state has elected the COBRA option and if state B has elected the option, then If the new state offers reciprocity and if state B does offer reciprocity, then How the new state extends reciprocity Is it extended to your state?

10. 10 © 2007 by The Interstate Compact on Adoption and Medical Assistance States without Reciprocity District of Columbia Hawaii Illinois Iowa Nebraska Nevada New Hampshire New Mexico New York

11. 11 © 2007 by The Interstate Compact on Adoption and Medical Assistance State-Funded Foster Care State funded foster care recipients can become eligible for Medicaid if they meet the eligibility requirements under one of the mandatory or optional needy groups. Examples: 42 CFR 435.222 (optional group) and Section 1931 of the SSA (mandatory group) The issue in interstate cases is one of residency. The general Medicaid residency requirements apply.

12. 12 © 2007 by The Interstate Compact on Adoption and Medical Assistance State-Funded Foster Care Eligibility and residency: State funded foster care eligible children retain the residency of the sending state (which retains custody). Therefore, they cannot receive Medicaid from the state in which they are physically located. The family will need to find a Medicaid provider in the state in which they reside that will take the child’s out-of-state Medicaid card.

13. 13 © 2007 by The Interstate Compact on Adoption and Medical Assistance Supplemental Security Income (SSI) 32 states and DC automatically provide Medicaid to children receiving SSI (so-called “§1634 states”) 7 states use eligibility criteria identical to that used for SSI, but require the filing of a separate application (so-called “criteria states”) 11 have opted to use eligibility criteria which is more restrictive than used for SSI in determining Medicaid eligibility (so-called §209(b) states)

14. 14 © 2007 by The Interstate Compact on Adoption and Medical Assistance §1634 states Alabama Arizona Arkansas California Colorado Delaware DC Florida Montana New Jersey New Mexico New York N. Carolina Pennsylvania Rhode Island S. Carolina Georgia Iowa Kentucky Louisiana Maine Maryland Massachusetts Michigan Mississippi South Dakota Tennessee Texas Vermont Washington West Virginia Wyoming

15. 15 © 2007 by The Interstate Compact on Adoption and Medical Assistance Criteria States Alaska Idaho Kansas Nebraska Nevada Oregon Utah

16. 16 © 2007 by The Interstate Compact on Adoption and Medical Assistance §209(b) states Connecticut Hawaii Illinois Indiana Minnesota Missouri New Hampshire North Dakota Ohio Oklahoma Virginia

17. 17 © 2007 by The Interstate Compact on Adoption and Medical Assistance SSI Interstate The Federal law: For any individual not residing in an institution…whose Medicaid eligibility is based on blindness or disability, the state of residence is the State in which the individual is living. 42 CFR 403(h)(20(b)

18. 18 © 2007 by The Interstate Compact on Adoption and Medical Assistance SSI Interstate CMS State Medicaid Manual: 3230.1 State of Residence Criteria Specific to Individuals Under Age 21 – A. Social Security Income (SSI) Related Individuals– For an individual not residing in an institution, whose Medicaid eligibility is SSI related, and is based on blindness or disability, the State of residence is the State where the individual is living. State Medicaid Manual, Chapter 3, Eligibility

19. 19 © 2007 by The Interstate Compact on Adoption and Medical Assistance SSI Interstate Whether the child retains Medicaid eligibility depends upon whether the new state is a §1634, criteria, or §209(b) state: §1634: retain Medicaid eligibility Criteria: retain eligibility, complete new application §209(b): may not be eligible

20. 20 © 2007 by The Interstate Compact on Adoption and Medical Assistance TANF Placement supported by child-only TANF payment: No automatic eligibility for Medicaid Must qualify for Medicaid through meeting the requirements for an optional or mandatory needy group May be eligible for low-cost health insurance under the State Children’s Health Insurance Program (SCHIP)

21. 21 © 2007 by The Interstate Compact on Adoption and Medical Assistance Residential Treatment Facilities The special exception to residency rules given to Title IV-E recipients does not apply to non Title IV-E recipients. Therefore, the child ineligible for Title IV-E placed in an out-of-state institution is considered a resident of the state which arranged for or actually made the placement, not the state where the RTF is located. Federal law: 42 CFR 435.403(e)